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Most oncologic emergencies can be classified as metabolic, hematologic, structural, or treatment related. Tumor lysis syndrome is a metabolic emergency that presents as severe electrolyte abnormalities. Stabilization is focused on vigorous rehydration, maintaining urine output, and lowering uric acid levels. Hypercalcemia of malignancy, which is associated with poor outcomes, is treated with aggressive rehydration, intravenous bisphosphonates, and subspecialty consultation. Syndrome of inappropriate antidiuretic hormone should be suspected if a patient with cancer has hyponatremia. This metabolic condition is treated with fluid restriction or hypertonic saline, depending on the speed of development. Febrile neutropenia is one of the most common complications related to cancer treatment, particularly chemotherapy. It usually requires inpatient therapy with rapid administration of empiric antibiotics. Hyperviscosity syndrome may present as spontaneous bleeding and neurologic deficits, and is usually associated with Waldenström macroglobulinemia. Treatment includes plasmapheresis followed by targeted chemotherapy. Structural oncologic emergencies are caused by direct compression of nontumor structures by metastatic disease. Superior vena cava syndrome presents as facial edema with development of collateral venous circulation. Intravascular stenting leads to superior patient outcomes and is used in addition to oncology-directed chemotherapy and radiation therapy. Malignant epidural spinal cord compression is managed in conjunction with neurosurgery, but it is classically treated using steroids and/or surgery and radiation therapy. Malignant pericardial effusion may be treated with pericardiocentesis or a more permanent surgical intervention. Complications of cancer treatment are becoming more varied because of the use of standard and newer immunologic therapies. Palliative care is increasingly appropriate as a part of the team approach for treating patients with cancer.

The National Cancer Institute estimates that 14.5 million persons in the United States have cancer, and that number could reach 19 million by 2024.1 Family physicians should be familiar with the most prevalent oncologic emergencies because stabilization is often necessary, in addition to referrals for managing the underlying malignancy and initiating palliative measures.2 Some oncologic emergencies are insidious and take months to develop, whereas others manifest over hours, causing devastating outcomes such as paralysis and death.3 In many patients, cancer is not diagnosed until a related condition emerges. A patient-focused approach that includes education; cancer-specific monitoring; and team-based care, including palliative care, with continuous communication is recommended.4 Most oncologic emergencies can be categorized as metabolic, hematologic, structural, or treatment related (Table 15).

Complications from newer immunotherapy treatments often present as nonspecific and vague symptoms, such as flulike illness and rash, requiring a high level of suspicion in patients undergoing cancer treatment.

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